Six Dangerous Falsehoods Peddled by the “Frontline” Heroin Special

Six Dangerous Falsehoods Peddled by the “Frontline” Heroin Special

“FRONTLINE investigates America’s heroin crisis in a searing two-hour special that premieres Tuesday, February 23,” trumpeted PBS. I saw the show’s producer on MSNBC’s Morning Joe, where everyone amen-ed the importance of Frontline’s heroin panic portrayal.

Unfortunately, every single major principle presented by Frontline was false, and adherence to them will likely cause more addiction and drug deaths.

I’ll limit myself to a half-dozen of the dangerous shibboleths they purveyed:

1. “Widespread use of narcotics automatically means greater addiction rates.”
Opiate use was near-universal in the 19th century, with no recognition that such drug use was particularly addictive. No one can read Virginia Berridge’s Opium and the People and think about narcotic addiction the same way again. Nineteenth-century Brits used opiates daily—gave them to babies—with none of the appearance of what we today would label “addiction.” Berridge’s book is the antidote to the American vision of the same phenomenon, David Courtwright’s Dark Paradise, which—myopically viewing the same period through contemporary lenses—says millions of 19th-century Americans were addicted to narcotics, only they didn’t know it. If only they were as smart as we are!

2. “Painkiller use should be feared because it leads to heroin addiction.”
Painkiller addiction and poisoning deaths hit record levels along with heroin addiction and poisoning deaths in 2014, according to CDC data and analyses. People addicted to painkillers are 40 times more likely to be addicted simultaneously to heroin. So it’s simply not true that painkiller use and addiction, on the one hand, leads downstream to heroin addiction, on the other. And what does it matter whether people are addicted to one versus the other? Being addicted to either is awful—heroin addiction is not inherently worse.

(Remember, the drug involved in Chris Christie’s viral video about the horror of drug addiction—in which his law school friend gave up his job, his family and, ultimately, his life—was Percocet.)

3. “We are just realizing that we give out painkillers too freely.”
Americans have feared painkiller prescriptions, along with all opioid use, since the beginning of the last century. US medicine is famous for underutilization of analgesics, both in hospitals and outside of them, leading to periodic reports like the Institute of Medicine’s—headlined in Influence columnist Maia Szalavitz’s Timearticle as “Chronic, Undertreated Pain Affects 116 Million Americans.”

Thus the US was slow to introduce self-regulated narcotic titration in hospitals, which leads to uniformly less painkiller use by patients. And, of course, fear of painkillers led to restrictive prescribing practices…which are now recognized as a major cause of the surge in heroin use!

One politician, albeit one no longer facing re-election, sensibly rejects these proposals. Not everyone is totally crazed. Barack Obama rejects the plan, because:

“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said during his meeting with the governors Monday. “In some cases, addiction is already there.”

Unfortunately Obama is leaving office before he can implement such a sound understanding (one which has not been evident in his administration’s drug policies to date).

The ratio of a fatal to a normal dose of heroin is almost 75-to-1. Heroin purity has been declining just as poisoning deaths have been increasing in the US. New York City, which has the best data on such deaths, finds that over 90% involve use of multiple depressant substances, including tranquilizers and alcohol along with painkillers and/or heroin. Telling people not to take pure narcotics increases their likelihood of using other drugs to “take the edge off,” which leads to more deaths.

5. “People can’t control their narcotics use.”
Every profile of narcotics users shows that they regulate their intake of drugs. As I recently pointed out in The Influence, a Super Bowl ad ran for opioid-based constipation—because tens of millions of Americans take prescription opioids and an estimated eight million suffer constipation as a result, although very few become addicted.

Nearly every one of us has used powerful narcotic painkillers. The reason we don’t believe these drugs are really addictive (like heroin) is because we ceased taking them when our pain ceased—the usual course of events.

But heroin is little different in the inconstancy of its use. In 2014, 1.8% of Americans had used heroin in their lifetimes. In the past month, 0.2% had done so. In other words, a little over a tenth of lifetime heroin users have used the drug in the past month.

Why are we unaware of them? “With public attention focused primarily on opioid painkillers,” a Times piece posits, “the role of anti-anxiety drugs ‘fell under the radar’.”

So how would you keep your own children from becoming addicted if, say, they broke a leg, or had their appendix removed, or had a wisdom tooth extracted and required a painkiller prescription?

Of course, it is valuable to be mindful of what pain is about and how to relieve it, along with potential dangers from painkilling drugs. But the single best antidote to addiction is that your kids have enough concern for themselves, appreciation for keeping a clear mind, and purpose in life that they will instantly reject continued narcotic use as being inconsistent with who they are—as I describe in Addiction-Proof Your Child.

Instead of misleading people about the inherent danger and addictiveness of heroin, and secondarily painkillers, we need to tell everyone, even children, that opioid use—like masturbation—has been ubiquitous throughout history: everyone does it; and, in itself, it is not a dangerous practice.

Rather, we should provide for them and expect them to adopt, which nearly all do, the life options that make addiction unlikely.

* Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.

* Death Rates: No one has died from a heroin overdose since the inception of the program. The heroin used is inspected for purity and strength by technicians.

* Disease Rates: New infections of Hepatitis and HIV have been reduced for patients in the program.

* New Use Rates: Slightly lower than expected. 1) As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it unattractive to young people. 2) Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.

* Cost Issues: 48 dollars/day: Patient costs are covered by national health insurance agency. Patients pay 700 dollars/year for the compulsory insurance. Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.

* In December 2008 the Swiss voted (68%-32%) to make the program part of their body of laws.

Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands and Denmark. Additional trials are being carried out in Canada and Belgium.

A clinical follow-up report on the German “Heroinstudie” found that 40% of all patients and 68% of those able to work had found employment after four years of treatment. Some even started a family, after years of homelessness and delinquency.

In the Netherlands, both injectable Diamorphine HCl as injectable salt in dry ampoules as well as Heroin base with 5-10% caffeine for vaporization are available.

I have been addicted to a number of drugs in my life. Mostly cannabinoids (natural and synthetic). I even spent a couple of years in therapy for my problems with marijuana and have since worked with an addiction support group on a voluntary basis.

A few years back I was diagnosed with gallstones and pancreatitis. Through this I was prescribed cocodamol (codeine and paracetamol/acetaminophen) and tramadol (a potent opioid generally described as being one step below morphine) and was given IV diamorphine (heroin) in hospital when the pancreatitis flared up. I love diamorphine, it feels great and tramadol produced some pretty great effects too.

I’ve never had the urge to use diamorphine outside of hospital and after 3 scripts (1 month supply each time) for tramadol I discovered that naproxen, a NSAID similar to ibuprofen, and cocodamol was infinitely more effective for my gallstone pain than the tramadol. It killed the pain without a high, rather than masked the pain and leave me feeling dopey and a little nauseous like tramadol. I stopped taking the tramadol without any difficulties.

I did have some problems with the codeine formulation but it took me about one month of cutting down the dose before, like with tramadol, I just stopped taking it after a full year of taking it daily at prescription strength.

The fact is that addiction is poorly misunderstood. When I abused cannabinoids I had a lot of stress and anguish in my life. In other words I sought to dull my mental pain. When it came to physical pain, as soon as the pain stopped I stopped the painkillers. And you know what? It was the same with my mental pain.

Stanton Peele

Such an emblematic (if at times sad/problematic) narrative of pain and (addictive) substance use, but at the same time of human resilience — of suffering, recognition, and overcoming (or, rather, righting).

I only wish we recognized this as the standard narrative, which it is, rather than the one ending in death (like Christie’s law school friend, addicted to Percocet).

My main prayer for you is that you become progressively less familiar with the varieties and nuances of pain medications, and perhaps concentrate (as appropriate to your physical and mental state) on yoga, walking, meditation, or needlepoint.

🙂 Stanton

Lorraine ER

Just had to correct something, tramadol is not ” a potent opioid” or one step below morphine.

KruciusNayl

Yes it is. Your personal experiences with it are irrelevant, if tramadol doesn’t work for you then you will be prescribed morphine. Maybe that’s different in the states where people pop opioids like people in normal countries take paracetamol but here in the real world, prescription wise, it is the step before morphine. Would you like me to go into more detail about poor metabolisers or its SSRI effects? Or are you just being pedantic and suggesting that it is actually an opiate and not an opioid because it can be acquired from natural sources?

Darlene Palumbo Woodring

I ‘ve used Tramadol, even though it makes me nauseous and I don’t really like it, precisely because it has ZERO psychoactive effects on me. Now I’m starting to hear that people are “abusing” Tramadol. Why? Do other people get a “high” from using it? I certainly don’t. It’s an effective pain reliever that’s safe to use at work and while driving, IMHO.

Olmy Olm

Tramadol does give some people a nice high when they take it. It’s a relatively mild opioid though (that is, as far as opiods go).

Tenstry

Of course heroin addiction is inherently worse. For one it is an illegal unregulated drug. This will put you in a dangerous circle of people/friends as you will be around drug dealers and criminals to obtain the drug. Also, who knows what you are getting. Is it actually heroin? Is it a lethal dose? Is it formaldehyde mixed with PCP? Who knows. Plus you may be shooting up which can lead to eventual sharing needles with a high risk of HIV infection and other diseases as well as general complications of shooting up. To say it is not inherently worse is bizarre.

Also, just generally, plenty of folks have had nurturing backgrounds, good self esteem and have had severe problems with addiction and drug and alcohol abuse. Just like there are people who come from opposite backgrounds and have no addiction issues. Some don’t even drink the most addictive substance in the world – coffee/caffeine.

The difference is individual biochemistry and to paint everyone the same requiring the same solution is simplistic and wrong.

Stanton Peele

Some good points. I did take the liberty of adding a new paragraph — directly from gov’t files (here: https://www.drugabuse.gov/drugs-abuse/heroin) — that about a tenth of people who have ever used heroin currently do so (1.8% lifetime vs. 0.2% used in the past month). Do you find it surprising to read — from a source, the US, that claims heroin is especially addictive? So people’s resistance to perpetual narcotics use carries over from painkillers to heroin — which IS, after all, a painkiller.

Yes, it is my view that addiction is ruinous, not the drug per se. Let me remind you that the paradigmatic case of a person dying from narcotics use was Chris Christie’s law school friend — who never took heroin, but “only” Percocet.

Your have revealed another of my strong biases — that beliefs determine addiction, in large part. Why all of a sudden are addiction and “overdose” (poisoning) rates increasing in all areas — alcohol, painkillers, heroin, tranquilizers, when the gov’t’s own data show heroin purity has declined in this period (see here: http://www.dea.gov/divisions/hq/2015/hq052215_National_Heroin_Threat_Assessment_Summary.pdf) and the National Survey on Drug Use and Health shows that nonmedical (illicit) painkiller use has not increased, but remained constant, in this time span? What IS going on, do you think?

Here is my most radical claim of all — there ARE NO people who find they can’t remove their drug addictions. Let me cite two remarkable sources. One is a strange monograph produced by DHHS in 2002 called “Those Who Continue to Smoke.” These anti-tobacco researchers were convinced they would find more psychologically vulnerable, more addicted smokers not to be able to quit. Research in the volume explored whether remaining smokers were more addicted in strictly biological terms than quitters, whether they had different biological or personality profiles, or whether cigarettes had somehow become more chemically addictive.

Despite great efforts, this research volume found, “Surprisingly, none of the papers presents compelling evidence that this is the case” (p. 2). On its last page (p. 143), the Monograph states, “In summary, these trends do not suggest that the population of smokers who remains is more addicted, more resistant to cessation messages, less likely to attempt cessation, or increasingly composed of those
with limited activities or poor mental health.”

Okay, forget cigarettes. The researcher who has most thoroughly investigated the NESARC data base, the remarkable Gene Heyman, found this incredible thing about quitting all drug and alcohol addictions:
“Although varied, the remission results were orderly. An exponential growth curve closely approximated the cumulative frequency of remitting for different drugs and different ethnic/racial groups. Thus, each year a constant proportion of those still addicted remitted, independent of the number of years since the onset of dependence.”

What we don’t know about addiction, what we impose due our prejudices and erroneous beliefs, is by far the largest part of the pie. AND, HERE’S THE THING. These misconceptions encourage people to doubt their resilience and ability to overcome, WHICH IS THE STRONGEST SINGLE DETERMINANT OF ADDICTION AND ITS CONTINUATION.

What do you think?

Tenstry

Hi Mr Peele.

I don’t know if I agree with “belief determines addiction”. I believe a lot of things determine it and perhaps its severity and quality including the way one is affected by a drug, which may be different from the way it affects another. People are different. If your brain for example is low on certain NTs and a drug amplifies them big time, way more than someone else for example who has a more normal brain chemistry but who may use the drug to relieve stress or hide from problems, then this person may have a different addiction experience and get different things out of it. I know from my own experience quitting cigarettes and other things, that it was never belief at least as I understand it that messed up my quits. I always went into a quit believing I can do and I will do it, even if I fail. I had real hope that I could do it. And I kept on trying to quit, countless times.

Maybe in one sense belief determines everything since maybe one could say this is the human condition in the sense we have a whole bunch of beliefs about everything and they inform our feeling emotions and influence behavior. But does knowing what we believe and trying to change that or see another way equal easy freedom from addiction? For people who are addicted. That I’m not so sure about.

What tripped me up with quitting cigarettes was not that I didn’t believe I could quit (I actually successfully quit believing I might not be able to do it), it was withdrawal and “PAWs” and powerful cravings that broke me so many times. Feeling horrible from not having the drug and also feeling like I really needed it – need it to take away the horrible feeling and need it to take away the craving. And if I did have it it pretty quickly took away the pain and craving and was actually pleasurable. And yes I also had the psych. associations and their triggers but it was more intense physical discomfort that had me going back.

I never really felt any help with the idea that, for example, if you believe you cannot tolerate the discomfort of cravings or withdrawal or whatever, you will fail. I thought I could weather it or learn to tolerate it or look at it as not as bad as getting hit by a plane for example and is not the worse thing.. but it didn’t quite work out that way for me in any planned cognitive way (not to say that these ideas are not helpful at all – it just didn’t seem much help with withdrawal).

For me with cigarettes for example, which I loved, in terms of my successful quit 18 years ago, I just had to go through a two month period of semi-depression and various other ill effects (quit cold turkey) and intense cravings and feeling horrible and it sucked. It took another 22 months (2 years total) until I felt normal again and had no thoughts of cigarette use no matter the trigger. Basically I was able to suffer through the quit with it very slowly getting better until I had enough time where it faded away. 2 years later its as if I never smoked. As I went through my successful quit, I actually doubted I could do it and wasn’t sure about it at all for a while. I just did it, and I held on to anything that bought me time and suffered through it and after a time I no longer smoked (10 lbs heavier – I guess not having nicotines excellent fat burning effects and appetite suppression working for me anymore). But I eliminated nicotine addiction. I do believe to say it is a hard thing to do is an understatement. That belief coming from the experience. Maybe it’s not that way for everyone.

You say “Here is my most radical claim of all — there ARE NO people who find they can’t remove their drug addictions” – but that’s not really known for sure right? At best I think you could say is these 200 studies all show 100% success or whatever. But you can’t know that everyone could be helped until you helped everyone I think.

Alcohol. Don’t most “alcoholics” or destructive drinkers for example never recover? I’ve read different things – that 30% do recover or 90% relapse. Alcoholism being defined lets say as daily very heavy drinking which if stopped might result in dangerous withdrawal – dependency. Maybe also including episodic binge drinking with its particularly toxic and damaging effect on the brain due to excitoxicity (more so than daily very heavy drinking). I’m not talking about AA rates or people quitting on their own, but in general?

Don’t we see examples all the time especially with easily available, legal, cheap and heavily promoted and advertised alcohol (it’s even healthy in moderation – carcinogenicity and dubiousness of certain studies aside) despite great stakes of people unable to stop where they destroy themselves and sometimes others around them? I know for example two people who quit heroin (they claimed cigarettes were harder) who now drink very heavy. They are not healthy. But then there are some who can quit on their own. Some who quit through AA following the program militantly. Or not militantly. Or many who don’t. But most don’t seem to quit successfully according to studies or at least some that I have read of. Just looking around there are many people who abuse drugs who have tried things, quitting on their own, AA, NA, CBT based programs, in patient programs, outpatient programs, moderation and have not had success. Maybe one could argue they are not doing it right or don’t have the right info or tools even having tried various things. But maybe they just can’t do it “right” or maybe there is no right for everyone.

Maybe you are right but I just don’t see it like that based on my experience and understanding.
I also believe based on what I have seen and myself that many people that have addiction problems or have had abuse or a problematic use style cannot moderate long term. I know there have been studies that suggest more people can moderate than some may believe but this has not been what I have seen. As an example (out of so many) I know someone somewhat close to me who drank very heavy. Most would have considered him a talented “alcoholic” with great ability to drink. He quit on his own brilliantly and went on to great success in his career – a nice story. 20 years. Later he drank non alcoholic beer for many years and stayed completely away from alcohol. But then he started with a little fancy wine. I remember he explained why not enjoy life? And he was able to maintain it for a while. “Normal” moderation. Says I don’t need it, i just enjoy it. I have it with dinner and match flavors. Now, he’s always with wine whenever I see him, and he looks surprisingly bad as he enjoys his drinks.

Tenstry

Then there is the issue of whether alcoholism and addiction is a disease or a choice.
I think it is a little of both. I think the first time anyone picks something up its a choice. A choice that may be influenced by various things. Someone may be tired and pick up a cup of coffee or try a cigarette. Or they may be shy and try a drink. Or there may be peer pressure. Or just curiosity. Or everyone is doing heroin in vietnam to cope. Or they may need to numb themselves against an abusive situation. But what happens after that? A person may have a constitution that is especially susceptible to drugs that for them effectively counters a “natural ” state they experience in a given environment. Or what about the affects from drugs themselves? Look at binge drinking. This causes brain damage faster than daily extreme alcoholism due to excitotoxicity during the breaks from drinking. This can affect ones ability to reason and make smart decisions… in effect it creates a brain functioning disease affecting things like executive functioning etc.Drug abuse can create “disease” in that it can affect ones ability to make intelligent choices, the withdrawal and craving syndrome aside.

I think its a little simple to just call all addiction a choice. And it it were that simple I don’t think there would be so much devastation caused by drug abuse and addiction since it would be recognized and people would just drop their habits. There are many people who don’t believe they are helpless or powerless against drugs but still find it very difficult to quit addictions.

This is similar to what a sex crime expert said about how to protect kids from sexual abuse: don’t raise your kids so that they’re starved for attention and seek it from those willing to exploit that need (here’s the awesome podcast where he talks about it http://mentalpod.com/archives/3990).